=====================================================
General NPI Number Information
=====================================================
NPI Number | 1154704013
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KAUFMAN DENTAL, P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/09/2015
-----------------------------------------------------
Last Update Date | 07/09/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3664 OLD SHELL RD
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36608-1311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-343-2404
-----------------------------------------------------
Fax | 251-343-2428
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3664 OLD SHELL RD
-----------------------------------------------------
City | MOBILE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 36608-1311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 251-343-2404
-----------------------------------------------------
Fax | 251-343-2428
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JAMES G. KAUFMAN
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 251-343-2404
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QD0000X
-----------------------------------------------------
Taxonomy Name | Dental Clinic/Center
-----------------------------------------------------
License Number | 4852
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------